Provider First Line Business Practice Location Address:
3400 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-2295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-722-9366
Provider Business Practice Location Address Fax Number:
574-722-5987
Provider Enumeration Date:
05/11/2007